Delight yourself in the LORD And He will give you the desires of your heart. Psalm 37:4

23 August 2018
Dear Friends,

I ride a 1993 BSA Deluxe – Indian-made bicycle with its seat jacked up – out our dirt lane into traffic, protected by one of the two rules of Kathmandu driving, which is Don’t hit anybody. (The other, Drive on the left, is flexible.) A motor scooter carrying two young ladies is bearing down on my bicycle, but it’s their job to slide out into traffic and avoid a collision. That’s just the way it works around here. Payback comes at the next intersection when a shiny Toyota SUV cuts me off to make a quick left hand turn. I jam on the brakes and mutter through his open window, to which he waves like I’m an old friend.

To reach the hospital in 15 minutes, I’ll navigate six stretches of rutted roadway. Up the first hill, I turn left and pass a cow ambling in the shadows of the razor-wired walls and lookout towers of the Army General and suddenly realize I’m speeding towards a construction pothole while pinned in by a motorcycle to my right. I slow just enough to miss the hole and tuck in behind the cycle, one puff of its exhaust hitting my face as it speeds away. The morning sun cuts an orange hole in the distant smog, warming me as it casts the dusty road sepia.

Next comes my first right-hand turn across traffic – through a busy four-way with no lights, no stop-signs, no traffic cop. Trusting in the magic of Nepali streets, where all lanes meld into a fluid mass, I slide towards the center-line, wait for a crack to appear in the opposing flow, and stick my nose into the first sliver of daylight. This impedes traffic enough to create a gap and I jam my way out the other side without a scratch.

On the road beside the zoo, I pedal under red-and-yellow-headed parakeets screeching in high wire-cages, and continue on to the Jawalakhel roundabout. Naturally, it has no right-of-way rules, so I slice into its swirl behind a fast motor scooter and in front of a dawdling bus, the late King Birendra placidly regarding us from his garden island.

The roundabout spits me out onto the Patan Hospital road, whose hazards include 1. Maruti taxis cutting me off (be cool); 2. Motorbikes playing chicken to cross to the opposite side (read their lean); 3. Pedestrians wading across four streams of traffic (read their garb: a city slicker will take care of himself, while a villager poses an unwitting menace); 4. Careening water trucks piloted by gleeful teenagers (yield).

I glance ahead to where the road brims with a seemingly impenetrable mass of traffic, but suddenly here’s the hospital, so I turn right and pass through its gate, grateful to enter as a doctor and not a casualty.

Two hours into ward rounds I come to her bed. It’s in a corner room lit by bright sky shining through the bare branches of a jacaranda tree, with six patients and their ten or so relatives milling about and filling the narrow gaps between the beds. The cream walls and tile floor emit a cool, faintly anti-septic smell, while a morning breeze through the window dilutes the odor of bodies and curried food. Bedside conversations hum with uncertainty, a mist-nebulizer machine whirrs, and two nurses chat confidently just outside the door.

Crowding her wooden bedside table are three mineral water bottles, a thermos, two apples in foam netting, an opened pack of digestive biscuits, a Frooti juice box and several crumpled foil medicine packets. A square of newspaper sits on a metal cup preserving its heat and cleanliness. Her husband’s bedroll is crammed beneath the white metal bed. He remains sitting on a stool beside her bed and says nothing.

She’s about 25 and has on standard hospital issue: a solid green pajama top with ties and a plaid wrap-around skirt. A brown-and-white blanket covers her lower legs. She has Guillain-Barre Syndrome, a nerve disease that has left her paralyzed, likely for months to come. The recommended treatment, an intravenous cocktail of antibodies, lies far beyond her family’s means.

“Namaste, Meena. How are you? Any better?”
“Not at all. I’m not the least bit better.”

With my left hand, I lift her right forearm from the bed. It’s smooth and latte-colored. Her hand flops over until I support it at the wrist, holding it with calloused palm towards her face. I raise my right hand just above and behind hers like a pale shadow.

“Move it like this.” My fingers dance effortlessly. Her brown eyes glisten as they fix on the two hands. “Go ahead.” After a pause, her index and middle fingers barely quiver, but they do move, once, twice, thrice. “Look! Look! Those are your fingers moving! You’ve gotten back some strength.”

I look at her. She catches her smile before it surfaces and says, “I don’t think they moved. At least they didn’t seem like it to me.”
“You will get better from this. You’ve already started to.” “I don’t see the point of staying here. I’m not going to get better, so we might as well
go home.”

Her husband has neither spoken nor changed his expression. As our team moves on to the next patient, I turn back to Meena and raise my
eyebrows in a silly expression. She rewards me with one genuine smile. I’ve always loved being a doctor. The wonder of medicine in Nepal, with its storybook characters and often-treatable diseases, is one of the reasons I’ve stayed here so long.

These last two years have been particularly fulfilling. I suppose that’s partly due to my long hiatus from full-time medicine while working in the Nick Simons Institute, as well as to returning to a hospital where I no longer have administrative responsibility. The academic atmosphere has improved since Patan Hospital morphed into a medical school. I like being on a team with junior doctors and students, whose eagerness to learn is contagious. (Most of them are younger than my bicycle.)

Of course, however much at home one feels here and however rewarding the work, there is the age-old issue of a getting a visa. Without this permission from the Nepali government, we have to return to our birth countries. My ten years with NSI had many delights, one of them being easy 5-year visas. Now in Patan Hospital, each year we sweat out another visa procurement process. To some extent this is understandable: there are now plenty of Nepali doctors, so the need for foreigners has diminished.

My working visa expired last May and I went onto a tourist visa as a bridge. Every few days my old friends, the Directors of our hospital and medical school, assure me that they’re working on my visa, seeking the next step, a letter from the Health Ministry. Now two and half months on the tourist visa have passed, with the maximum being five, and I’ve not
seen much progress. The clock is ticking faster.

Please pray for this: that we get the visas to stay in Nepal. Zach has just started a challenging two-year academic course at the British School before he goes off to college. Benjamin is still at KISC, also in a two-year program that should not be broken. I’d planned to work for a four-year stint at Patan Hospital (until summer 2020) and Deirdre is making headway in building up Patan’s dietetics services. So, personally, we’d like to stay.

However, if God has some other plan for us, please pray that He would make that clear. It’s been an adventure with Him all the way, and (we hope) we’re ready for more.

Mark, Deirdre, Zachary, and Benjamin
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